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Posted: 10/12/2026Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in investigating healthcare insurance claims, analyzing data for fraudulent activities, and preparing detailed reports. Proficient in utilizing Excel for data analysis and maintaining accurate electronic case files.
Highest-signal resume keywords
Investigative ExperienceExcel ProficiencyData AnalysisCPT Coding FamiliarityHealthcare Insurance Knowledge
About the role
Key responsibilities & impact- Investigate assigned cases
- Collect, research, and analyze claim data to detect fraudulent, abusive, or wasteful activities and practices
- Use system tools and databases to analyze data and review professional and facility claims
- Detect fraudulent, abusive, or wasteful healthcare insurance payments to providers and subscribers
- Prepare statistical and financial analyses and reports documenting findings
- Maintain up-to-date electronic case files for management review
- Prepare final case reports and notification-of-findings letters to providers
- Receive settlement offers for review and discussion with management
- Communicate findings to internal and external customers
Requirements
What you’ll need- BA/BS required
- Minimum of 2 years related experience
- Related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, or law enforcement
- Any combination of education and experience providing an equivalent background
- Investigative experience preferred, such as health insurance or law enforcement
- Excel proficiency strongly preferred
- Ability to run pivot tables and analyze large datasets
- Familiarity with CPT coding preferred
- Ability to communicate orally and in writing with internal and external customers
- Candidates must be within a reasonable commuting distance from the posting location(s), unless an accommodation is granted as required by law
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Virtual full-time work arrangement, except for required in-person training sessions
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data AnalysisStatistical AnalysisFinancial AnalysisReport PreparationCase Investigation
Soft Skills
Oral CommunicationWritten Communication
Tools & Technologies
System ToolsDatabasesExcel
Industry Keywords
Healthcare InsuranceFraud DetectionClaims OperationsGrievance and AppealsLaw Enforcement